This file photo dated July 4, 2018 shows an entrance to Tokyo Medical University in Tokyo's Shinjuku Ward. (Mainichi)

An education ministry survey of 81 medical schools nationwide that revealed the ratios of successful male and female applicants on entrance examinations has drawn criticism for not providing an answer to the public's biggest question: whether sexism played a role in the selection process.

The Ministry of Education, Culture, Sports, Science and Technology conducted the survey in response to a sexism scandal at Tokyo Medical University. An internal probe found in August that the school manipulated entrance exam scores to lower the number of female admissions to avoid labor shortages at its affiliated hospitals because school officials deemed women doctors tend to leave work for pregnancy and child-rearing, and therefore could not work long hours.

The August survey found that the ratios of medical schools that accepted more female applicants than male counterparts during the six-year period ending in 2018 were between 56.79 percent and 71.25 percent.

A ministry official told reporters at a press conference announcing the survey results that the ministry is going to analyze the reasons why more male students were admitted to those schools.

In the survey, the ministry asked whether the medical schools padded the scores of some applicants or not, and whether they treated applicants differently because of their sex. Understandably, all schools except Tokyo Medical University said no to those queries, as those universities had no reason to admit to such illicit actions because doing so would result in cuts in ministry subsidies.

The ministry official said one university suggested that the school ended up accepting more men than women because "the math and physics tests were difficult," but no objective data exists to support the claim that women lag behind men in those two subjects.

Ministry officials will visit universities with particularly high ratios of successful male applicants for interviews. But medical schools are allowed to determine who they admit, and the education ministry has no legal authority to verify the validity of their entrance examinations by, for example, checking each and every answer sheet. It is unclear if the government can find out if other medical schools were guilty of sexism in their implementation of entrance tests.

The ministry is not against setting sex-based admission quotas "if the arrangement has proper goals and they are clearly stated in application documents." The ministry does not clearly explain what it means by "proper goals," but it is possible that Tokyo Medical University's motivation of turning down female doctors who cannot work long hours due to pregnancy and child-rearing could be construed as such.

Akira Takebayashi, who heads the Promedicus preparatory school for medical school applicants, is angry at the responses from the schools. "They didn't answer what applicants want to know," he said.

Takebayashi continued that suspicions still remain about the possibility of medical schools allowing entrance exam marks to be manipulated at the discretion of scorers. Tokyo Medical University padded the scores of male candidates in the second phase of its two-tier tests, which included interviews and essay writing. "I don't feel my male students are better than their female counterparts," Takebayashi said.

According to a male professor who has been involved in the entrance examinations of multiple private universities, some schools go the extra mile to guarantee the fairness of their scoring process. In one instance, the names and application numbers of candidates are removed from their answer sheets, and the final mark is determined by averaging scores given by multiple examiners, he explained.

The score padding and sexism scandals at Tokyo Medical University were said to be "the tip of the iceberg," but the latest education ministry survey did little to reduce suspicions against other medical schools. "The ministry should not let the universities keep their independence in this case. They should make scoring procedures for interviews and essays transparent, and make sure that entrance exams are fair," said Takebayashi.

-- -- Regional schools taking in more female applicants

In the meantime, the ministry probe also revealed efforts by local universities to admit more female students in a bid to ease the shortage of doctors. Schools such as Hirosaki University, Gifu University, Tokushima University, Mie University and Ehime University have had higher ratios of successful female applicants than male applicants for the past six years.

The overall number of male applicants stood at around 77,000, exceeding that of women -- approximately 48,600 -- by almost 60 percent in fiscal 2018. But the number of male applicants has remained around that level for years, while an increasing number of female applicants are seeking medical careers.

This trend is said to have been accelerating since the 2000s when local medical schools started to admit applicants on the grounds that they will work in regional medical institutions following their graduation. Local cities are also introducing programs so that female doctors can have both a career and a family.

In the central Japan prefecture of Shizuoka, where the ratio of doctors per residents is ranked 41st among the nation's 47 prefectures, a support center for women doctors was opened at the Hamamatsu University School of Medicine in 2014. The center has since introduced a program so that following childbirth, female doctors can work at a slower pace of once a week before resuming a fulltime schedule. Starting last fiscal year, the Shizuoka Prefecture Government commissioned an organization to run the program so that it covers the entire prefecture. The support facility receives about 60 inquiries a year, and two female doctors who gave birth actually used the program before their full return to work.

"In order to dispatch a limited number of doctors throughout the prefecture, we need to create an environment in which female doctors can work," explains assistant professor Chizuko Yaguchi, an obstetrics and gynecology specialist who is on the board of management for the support program at the Hamamatsu school. "Only big cities have the luxury to say, 'We don't want women,'" she added.

In 2007, Kyushu University Hospital in southern Japan invested education ministry subsidies to create a "step-up outpatient program" where female doctors can see outpatients on a part-time basis while raising children. Years of work under the program can be counted toward work experience necessary to be certified as a specialist physician, and it is designed to support returning women doctors to resume full-time shifts after three years. It is known as a successful example of a program that supports female physicians.

The Akita Medical Doctor Support Center, established by the Akita University Faculty of Medicine and the prefectural government in northern Japan in 2013, goes further in backing up medical professionals. The facility supports married doctor couples. As many female doctors are married to male doctors, the center organizes meetings for husbands where they can discuss and exchange information about how to manage household tasks and care for their children.

Associate professor Naoko Hashunuma, a dermatologist at the center, emphasized the need to support women physicians. "Women want to keep working. Local communities have a shortage of doctors, and I want capable female doctors to play a greater role," she said.